Case Study Nursing

Introduction

The current assignment explores a case study of V.G. a 47-year-old African American male. Two years ago, V.G. was diagnosed with type 2 diabetes and has been complaining elevated tingling on his lower extremities. According to his past medical history, V.G had hypertension, dyslipidemia, and obesity denied the use of alcohol and quitted smoking two years ago. Socially, he lives alone and relies on welfare and food stamps. According to his chart, V.G takes Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415 but he lost the medication a week ago. 

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Primary diagnosis

Based on his history of type 2 diabetes and increased complains of tingling on his lower extremities, the primary diagnosis is diabetic neuropathy. Pop-Busui et al (2017) explain that diabetic neuropathy presents with sharp cramps and pain, burning or tingling sensation, numbness and reduced sensation to temperature changes and pain, muscle weakness, and increased sensitivity to touch. To examine for diabetic neuropathy, there is a need to check V.J.’s sensitivity to vibration and touch, tendon reflexes, and general muscle tone and strength. 

Differential Diagnosis

According to Albers and Pop-Busui (2014), a diabetes diagnosis is straightforward among patients with polydipsia and polyuria but there are the limitation of differential diagnosis to diabetes insipidus, type 2 diabetes, and type 1 diabetes. However, for diabetes neuropathy, the differential diagnosis includes B-12 deficiency, pernicious anemia, and alcoholism. Although V.G denies previous use of alcohol, alcohol abuse is a major cause of neuropathy and such individuals may feel tingling and burning sensations on their lower extremities. 

The second differential diagnosis is pernicious anemia which is as a result of an autoimmune attack on the stomach’s parietal cells. Staff and Windebank (2014) explain that vitamin B12 deficiency causes sub-acute combined degeneration of the neuropathy and spinal cord. However, the differential diagnosis is that V.G has a history of diabetes which eliminates the possibility of peripheral neuropathy. The third differential diagnosis is pernicious anemia which according to Staff and Windebank (2014) is the major cause of degeneration of the lateral and posterior column of the spinal cord and peripheral neuropathy.

Physical Examination

Buttaro et al (2016) explain that while diagnosing for diabetes, a health professional should conduct a physical examination that centers on weight loss, dehydration, and precipitating factors like stress, infections, and illnesses. It is essential to conduct a physical examination on vital signs like blood pressure, body mass index (BMI), weight, height and due to the earlier history of type 2 diabetes and tingling on lower extremities; there is a need to take orthostatic measurements. Buttaro et al (2016) provide the need for examining the eyes through the funduscopic exam for exudates and hemorrhages.

Another element is examining the oral cavity for gum lesions, fungal infections, or diseases. This is followed by thyroid gland palpation to check any enlargements. Buttaro et al (2016) also call for cardiac examination to auscultate heart rate for clicks, murmurs, rhythm, or other heart sounds. There is a need to examine the skin for any signs of acanthosis nigricans, ulcers, redness, infection, and irritation. Lastly, is feet examination where Buttaro et al (2016) explains on palpating pulses for the presence of Achilles reflexes and monofilament examination to check for protective sensation. One of the likely symptoms for diabetes is that a patient may appear flushed and dry. 

Potential Treatment Options

Buttaro et al (2016) explain that diabetes treatment includes self-care education, monitoring, medication, regular exercise, healthy diet, and periodical follow-up with the diabetes care team or the primary provider. The core goal for diabetes treatment is to help V.G attain the bet glycemic control without undue adverse effects and burden. One option for V.G is nutritional therapy where he requires assistance on meal plans and healthy nutrition. The core goal of this therapy is to ensure he attains a glycemic control, balance insulin with the foods consumed, and formulate a healthy plan. Besides, V.G has a history of obesity which requires nutritional therapy to achieve and maintain adequate blood pressure, healthy weight, good glycemic control, and adequate lipid levels.  

According to Pop-Busui et al (2017), diabetes neuropathy has no cure and the major goals for treatment include managing complications and restoring function, pain relieves and slows the progress of the disease. V.G should maintain a blood sugar level of lower than 180 mg/dL (10.0 mmol/L) 2hours after meals and 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals. Treatment management or pain-relieving includes the use of antidepressants and anti-seizure drugs. Lastly, is the need to manage complications and restore function where for example, V.G requires a neurologist to manage any neuro-related side effects.

The second intervention is physical exercise and activities which according to Buttaro et al (2016) improves glycemic control. Staff and Windenbank (2014) explain that physical activities promote the uptake of glucose by skeletal muscles and improve insulin sensitivity. Besides, V.G.  requires to reduce his medication instead of increasing the amount of food consumed to reduce his weight. In additional to lifestyle interventions, V.G requires managing diabetes neuropathy through pharmacotherapy regimes. Presently, V.G is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415. Lispro is one insulin analog that acts rapidly for diabetic neuropathy. Other intervention for V.G includes periodical monitoring of glucose to achieve and maintain glycemic control. The last aspect is introducing follow-up care where a health professional determines the severity and the frequency of hypoglycemic events.

Reference

Albers, J. W., & Pop-Busui, R. (2014). Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Current neurology and neuroscience reports14(8), 473.

Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2016). Primary Care a Collaborative Practice (5th ed.).

Pop-Busui, R., Boulton, A. J., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., … & Ziegler, D. (2017). Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes care40(1), 136-154.Staff, N., & Windebank, A. (2014). Peripheral Neuropathy Due to Vitamin Deficiency, Toxins, and Medications. CONTINUUM: Lifelong Learning In Neurology20, 1293-1306. doi: 10.1212/01.con.0000455880.06675.5a

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